Good post-transplant outcomes using liver donors after circulatory death when applying strict selection criteria: A...

Area of Science:

• Transplantation immunology
• Organ transplantation
• Surgical outcomes

Background:

• Liver transplantation (LT) outcomes with donors after circulatory death (DCD) have historically been suboptimal, particularly concerning ischemic cholangiopathy when using the super-rapid recovery (SRR) technique.
• This perception necessitates a comparative analysis to evaluate the safety and efficacy of DCD donors versus donors after brain death (DBD) in a high-volume liver transplant center.

Purpose of the Study:

• To compare the incidence of complications in liver transplant recipients who received grafts from DCD donors versus DBD donors.
• To assess the impact of different DCD recovery techniques (SRR and normothermic regional perfusion [NRP]) on transplant outcomes.

Main Methods:

• A retrospective cohort study was conducted, comparing 51 LT recipients with DCD donors to 51 matched LT recipients with DBD donors.
• Propensity score matching was employed, considering LT indication, recipient/donor age and sex, and MELD score.
• Data were collected for LT procedures performed between January 2015 and December 2018.

Main Results:

• Biliary complications were more frequent in the DCD group (10%) compared to the DBD group (2%), primarily associated with the SRR technique.
• Primary graft non-function occurred in 4% of DCD recipients versus 0% of DBD recipients.
• Postoperative bleeding and reintervention rates were higher in the DCD group (13.7% vs 1.95% and 15.7% vs 3.9%, respectively).
• Peak AST/ALT levels on postoperative day 1 were significantly higher in the DCD group (p≤0.0001).
• Rejection, vascular complications, renal injury, hospital stay, and readmission rates were similar between groups.
• Cumulative 1-, 2-, 3-, and 4-year graft and patient survival rates were comparable for both DCD and DBD liver transplantation.

Conclusions:

• Donors after circulatory death (DCD) represent a viable option to expand the donor pool for liver transplantation.
• The normothermic regional perfusion (NRP) technique appears to mitigate some risks associated with DCD liver transplantation, leading to outcomes comparable to those of donors after brain death (DBD).
• DCD donors, particularly when utilizing the NRP technique, can achieve similar graft and patient survival rates to DBD donors, making them an adequate choice for increasing donor availability.